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Efficacy and safety of therapy with the phosphodiesterase type 5 inhibitor, sildenafil, in patients with diastolic heart failure and reactive pulmonary hypertension

Gavryushina S. V., Ovchinnikov A. G., Ageev F. T.
Federal State Budgetary Institution, “Russian Cardiology Science and Production Center” of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: diastolic CHF, reactive pulmonary hypertension, phosphodiesterase-5 inhibitors, sildenafil

DOI: 10.18087/rhfj.2016.3.2225

Background. Approximately one-third of diastolic HF (DHF) cases are complicated with development of reactive pulmonary hypertension (PH). In DHF patients, isolated elimination of the PH reactive component may entail abrupt increase in venous pulmonary pressure and pulmonary edema. Therefore, treatment of reactive LH should influence both the reactive pulmonary component and the disordered LV diastolic function. Both goals can be achieved by using the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil. Aim. To evaluate effects of the PDE5 inhibitor, sildenafil on the functional status, pulmonary artery pressure and heart diastolic function in patients with DHF and reactive PH. Materials and methods. The study included 50 patients with FC II-III CHF with preserved LV systolic function (LV EF >50 %), high mean LA pressure and LV filling pressure, and reactive PH. Patients were randomized to the PDE5 inhibitor sildenafil treatment group (n=30) and the control group (n=20). Sildenafil was administered at a dose of 25 mg 3 times daily for the first 3 months and then 50 mg 3 times daily for the next 3 months. General clinical examination, ECG, determination of CHF NYHA FC, completing the Minnesota Living with Heart Failure Questionnaire, 6-min walk test, and transthoracic EchoCG were performed at baseline, at 3 and 6 months for all patients. Results. The PDE5 inhibitor treatment was safe, resulted in rapid functional improvement, reduced the mean CHF FC, and increased the 6-min walk distance (by 49±8 m; р<0.05), which was achieved due to reduction of mean pulmonary artery pressure (MPAP) by 17±1 mm Hg (р<0.01) and pulmonary artery wedge pressure (PAWP) by 2.9±1 mm Hg (р<0.05). Conclusion. At the stage of reactive PH in patients with DHF, sildenafil at a dose of 75–150 mg/day effectively improved the functional condition of patients and reduced pulmonary artery pressure. Furthermore, the increased blood flow to left heart chambers was compensated by improved processes of LV relaxation, which allowed to avoid an increase in LV filling pressure.
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Gavryushina S. V., Ovchinnikov A. G., Ageev F. T. Efficacy and safety of therapy with the phosphodiesterase type 5 inhibitor, sildenafil, in patients with diastolic heart failure and reactive pulmonary hypertension. Russian Heart Failure Journal. 2016;17 (3):173–180

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